New Center Treats Painful Condition that Threatens Fertility

SLUCare/St. Mary’s Specialist Brings Hope to Women With Endometriosis

ST. LOUIS -- Saint Louis University's new Center for Endometriosis at SSM St. Mary's Health Center offers new treatment options -- including potentially curative minimally invasive laser excision surgery -- to women who suffer from a common condition that can cause pain and infertility.

"Women with pelvic pain are often written off, given pain medications, and told what they're experiencing is normal," said Patrick Yeung, M.D., a SLUCare gynecologist who specializes in treating endometriosis. "It's a real disservice. A woman doubling over in the fetal position on the floor with pain during her period, missing work or school -- that's not normal."

Common problem

A U.S. study showed that endometriosis is under-diagnosed, taking up to 12 years until a surgical diagnosis is achieved. Endometriosis is estimated to affect 1 out of every 10 women in their childbearing years, including 5 million U.S. teenagers.

While not all pelvic pain is caused by endometriosis, pain is the most common symptom of endometriosis, Yeung noted. Many do not realize they have the condition and consequently do not seek treatment for their pain. In addition to pelvic pain, endometriosis can be associated with other symptoms including painful bowel movements or cramping, pain with intercourse and fatigue.

Between 25 to 65 percent of women with endometriosis have fertility problems.

Endometriosis occurs when the tissue that normally lines the inside of a woman's uterus and shed during her menstrual period is found implanted in another part of her body, where it does not belong.

Research findings

Earlier this summer, Yeung published research that defies current medical thinking -- namely, many believe that endometriosis always comes back, particularly in teenagers, despite surgical or medical treatments to manage it. Laparoscopic (or minimally invasive surgery) excision was performed using a carbon dioxide laser by experts with experience in recognizing common and subtle forms of endometriosis. They removed lesions caused by endometriosis in a group of 20 teenagers.

Almost half of the teens were checked an average of two years, and up to five years, after the procedure, and Yeung said none were found to have endometriosis. Overall, their symptoms of pain were much better, and their quality of life was significantly improved.

Of note, after the procedure, only a third of the teens took hormones, which are commonly prescribed after surgery to slow or stop the growth of endometriosis that is thought to have been missed or always comes back. This means the majority (two-thirds) of the patients took no hormones after surgery, and still none had endometriosis on second look.

"My research showed that excision is clearly part of a plan to manage endometriosis, findings that we incorporate in caring for patients at the Center for Endometriosis," Yeung said.

Innovative approach

Most gynecologists who treat endometriosis do so by trying to destroy the implants with energy, called ablation. This approach, Yeung said, treats only the tip of the iceberg because endometriosis can invade deeper. In contrast, Yeung treats endometriosis using excision, which cuts out the implants entirely, and sends all specimens to pathology to confirm the disease.

"Used in the hands of a trained and experienced physician, laparoscopic excision has the potential to eradicate the disease, which has important implications in preserving fertility for women who have endometriosis," Yeung said.

SLU's Center for Endometriosis at SSM St. Mary's is the first in the region to excise endometriosis with a carbon dioxide laser. The laparoscopic procedure is minimally invasive -- requiring only a tiny incision through the naval and two small incisions below the bikini line. Patients usually go home the same day, and within a week or two are back to work or school.

Dr. Yeung's background

Yeung, who founded and directs the new Center for Endometriosis, comes to Saint Louis University and SSM St. Mary's Health Center with extensive experience in treating endometriosis. Before joining SLU this summer, Yeung founded Duke University's Center for Endometriosis Research & Treatment, which he directed for three years. Yeung will continue his research at SLU improving laparoscopic excision for treating endometriosis; developing ways to reduce adhesions, which is scar tissue that occurs after surgery; and ultimately trying to find a real cure or vaccine for the disease.

Yeung received his medical degree from Queen's University in Ontario, Canada, and completed his residency in Obstetrics and Gynecology at Georgetown University. He also completed a one-year fellowship in Minimally Invasive Gynecologic Surgery at the University of Louisville, and had advanced training in the laparoscopic excision of endometriosis using the carbon dioxide laser at the Center for Endometriosis Care in Atlanta.